Relevance of Distal Arterial Collapse in Stenting of Atherosclerotic Near-Occlusion of the Carotid Artery

Abstract

BACKGROUND AND PURPOSE: Carotid near-occlusion has been subclassified into near-occlusion with and without collapse. We aimed to compare the technical success and perioperative complication rates of carotid artery stent placement with special attention to these subtypes to see whether there is a clinical relevance of this subclassification.

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

“…Unlike other carotid artery stenoses, pre-operative intracranial perfusion was especially poor in patients with CNO, so we should attach great importance to the prevention and treatment of CHS. Cay et al ( 26 ) treated 59 CNO patients with CAS, 8.6% of the patients suffered from hyperperfusion syndrome during the periprocedural period. Strict blood pressure control, drugs for preventing brain edema, and oxygen-free radical scavenging drugs could decrease the incidence of CHS ( 27 ).…”

Dilation of proximal internal carotid artery collapse due to severe distal stenosis after angioplasty for distal stenosis: A case report

“…[ 14 ] In addition, it has been reported that CAS failed due to difficulty in system delivery, causing dissection and spasm. [ 1 , 10 , 12 ] Therefore, device induction into a collapsed ICA should be done with caution. Wingspan does not have good vessel tracking, and the condition of the vessels proximal to the stenosis makes it difficult to guide it to the stenosis.…”

The periprocedural and 30-day outcomes of carotid stenting in patients with carotid artery near-occlusion

“…None of the modern prospective carotid revascularization trials, such as the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) 8 , 9 and International Carotid Stenting Study (ICSS) 10 , 11 , included CANO patients. Several recent observational studies reported improvement in cerebral hemodynamics and cognitive functions, and reduced risk of stroke after carotid artery stenting (CAS) in CANO patients 12 – 15 . However, the technical difficulty and risk of periprocedural complications, especially hyperperfusion syndrome, may be underestimated and should be investigated 12 , 16 .…”

“…Several recent observational studies reported improvement in cerebral hemodynamics and cognitive functions, and reduced risk of stroke after carotid artery stenting (CAS) in CANO patients 12 – 15 . However, the technical difficulty and risk of periprocedural complications, especially hyperperfusion syndrome, may be underestimated and should be investigated 12 , 16 . We hereafter reported our results of CAS in CANO patients.…”